超声引导测量下腔静脉直径在拟行神经外科手术患者容量评估中的应用-东南大学学报医学版

超声引导测量下腔静脉直径在拟行神经外科手术患者容量评估中的应用

单位：1. 江苏省连云港市第一人民医院麻醉科, 江苏连云港 222000;
2. 南京医科大学康达学院基础医学部, 江苏连云港 222000

分类号：R445.1

出版年·卷·期（页码）：2018·37·第一期（117-120）

摘要：

目的：探讨拟行神经外科手术患者下腔静脉（IVC）直径的变化及其与每搏量指数（SVI）的关系，评价超声引导测量IVC直径预测患者容量反应的准确性。方法：30例术前禁食的准备行神经外科手术的患者，入手术室记录初始平均动脉压（MAP）、血氧饱和度（SPO₂）、心率（HR）、每搏量变异（SVV）以及每搏量指数（SVI）、超声引导下测量IVC的最大值和最小值（IVCmax，IVCmin）、计算下腔静脉的呼吸衰减指数（IVC-CI）。经过液体治疗以后，测量并记录MAP、SPO₂、HR、SVV、SVI及IVC的数值。将SVI增加大于10%定义为容量反应性阳性。结果：30例患者经过液体复苏后，其IVC最大直径增加35.0%（P < 0.01），最小直径增加23.2%（P > 0.01），IVC-CI下降18.2%（P > 0.01），SVI增加18.5%（P < 0.01）。IVCmax与同期的SVI呈正相关（P < 0.01），而IVCmin及IVC-CI与SVI则未出现显著相关（P > 0.01）。结论：超声引导下测量IVC的最大直径可用于预测神经外科手术患者容量反应性及指导术中液体治疗，并为判断患者的容量水平提供一定的参考依据。

Objective: To evaluate IVC diameters and explore the correlation of these findings with stroke volume index (SVI) for prediction of fluid responsiveness with ultrasound in patients undergoing neurosurgical surgery. Methods: Forty patients with preoperative fasting who scheduled for neurosurgical surgery were enrolled in the study. The maximum and minimum IVC diameters (IVCmax, IVCmin) was measured in hypovolemic patients with ultrasonography both before and after fluid resuscitation. SVI > 10% was defined as fluid responsiveness positive. Results: Thirty patients underwent IVC sonographic measurements and SVI calculation. After fluid resuscitation, there was a significant increase in the mean diameters of the IVCmax and SVI in these patients (P<0.01). The correlation coefficient between the IVCmax and the percentage increase in SVI after an intravenous fluid was 0.89. IVCmin and IVC-CI had no significant correlation with SVI. Conclusion: Ultrasonographic measurements of IVC diameters could be a useful noninvasive tool for the prediction of fluid responsiveness in patients undergoing neurosurgical surgery.

参考文献：

[1] SEIF D, MAILHOT T, PERERA P, et al. Caval sonography in shock:a noninvasive method for evaluating intravascular volume in critically ill patients[J].J Ultrasound Med, 2012,31(12):1885-1890.
[2] 张小宝, 冯继英, 朱品, 等. 超声引导下血管旁和神经旁穿刺行臂丛神经阻滞的效果[J].上海医学, 2015,38(2):155-156.
[3] CELEBI YAMANOGLU N G, YAMANOGLU A, PARLAK I, et al. The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method?[J].Am J Emerg Med, 2015,33(3):433-438.
[4] 尹万红, 陈瑶, 金晓东, 等. 床旁超声监测颈总动脉峰流速变异用于评估外科ICU患者容量状态的研究[J].四川大学学报:医学版, 2013,44(4):624-628.
[5] ZHANG Z, XU X, YE S, et al. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients:systematic review and meta-analysis[J].Ultrasound Med Biol, 2014,40(5):845-853.
[6] VERGNAUD E, VIDAL C, VERCHERE J, et al. Stroke volume variation and indexed stroke volume measured using bioreactance predict fluid responsiveness in postoperative childrendagger[J].Br J Anaesth, 2015,114(1):103-109.
[7] LI L, LI Y, XU X, et al. Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients:a meta-analysis of randomized controlled trials[J].Crit Care, 2015,19(1):79.
[8] 乔晖, 张军, 梁伟民. 收缩压变异度和脉压变异度预测神经外科手术患者容量反应性的准确性[J].中华麻醉学杂志, 2013,33(3):382-383.
[9] HE B, XU B, XU X, et al. Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit:a meta-analysis of randomized controlled trials[J].Crit Care, 2015,19(1):92.
[10] VASSAL O, DEL CARMINE P, BEURIAT P A, et al. Neurotoxicity of intrathecal 6% hydroxyethyl starch 130/0.4 injection in a rat model[J].Anaesthesia, 2015,70(9):1045-1051.
[11] 刘拴虎, 刘雅丽, 刘阳, 等. 超声探测下腔静脉快速评估高龄脓毒症休克患者血容量的价值[J].中国老年学杂志, 2013,33(13):3210-3211.
[12] 朱雷, 赵志斌, 冯继英, 等. 超声引导测量下腔静脉直径用于快速评估术前老年患者血容量的价值[J].山东大学学报:医学版,2014,52(10):96-99.
[13] ZHANG X, LUAN H, ZHU P, et al. Does ultrasonographic measurement of the inferior vena cava diameter correlate with central venous pressure in the assessment of intravascular volume in patients undergoing gastrointestinal surgery?[J].J Surg Res, 2014,191(2):339-343.
[14] MARIK P E, CAVALLAZZI R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense[J].Crit Care Med, 2013:41(7):1774-1781.
[15] MARIK P E, BARAM M, VAHID B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J].Chest, 2008,134(1):172-178.

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